Operative Management of Lumbar Degenerative Disc Disease

Abstract

Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term.

Effect of Coflex interspinous stabilization on the prevention of progression of adjacent segment degeneration after single level and skipped level spinal fusion in a canine model

“…Rigid spinal fusion is the most popular surgical procedure in the management of lumbar instability or lumbar disk herniation (LDH) [11]. Though rigid fusion has been proved to be an effective way to restore the disc space height, reconstruct the stability and alignment of spine, a variety of complications had emerged such as adjacent segment disease with the change of spinal mechanical activities [12]. The rigid fusion decreased the flexibility and mobility of the entire lumbar spine, leading to the center of rotation of vertebral body shifts over the disc, consequently, the stress on the facets and/or disc of the adjacent mobile segment significantly increased [4].…”

Biomechanical Changes of Degenerated Adjacent Segment and Intact lumbar Spine after lumbosacral Topping-off surgery: A Three-dimensional Finite Element Analysis

“…In order to avoid the occurrence of ASDeg, a variety of dynamic internal fixation systems are gradually used in clinical practice, including interspinous dynamic internal fixation system, transpedicular dynamic rod fixation, artificial disc replacement, etc. [4] . Although interspinous dynamic internal fixation system, to some extent, can delay the emergence of ASDeg, fusion is often required in order to achieve fully decompression and stability for patients with severe spinal stenosis or lumbar instability [5,6] .…”

Biomechanical changes of degenerated adjacent segment and intact lumbar spine after lumbosacral topping-off surgery: a three-dimensional finite element analysis

“…It is now generally accepted that increasing the fusion length promotes the occurrence of ASDeg [1][2][3]. In order to avoid the occurrence of ASDeg, a variety of dynamic internal fixation systems are gradually used in clinical practice, including interspinous dynamic internal fixation system, transpedicular dynamic rod fixation, artificial disc replacement, etc [4]. Although interspinous dynamic internal fixation system, to some extent, can delay the emergence of ASDeg, fusion is often required in order to achieve fully decompression and stability for patients with severe spinal stenosis or lumbar instability [5,6].…”